It makes intrinsic sense that integrated approaches working across development sectors are a good thing – especially when it comes to the complex issues facing people in developing countries and the environment in which they live. After all, integration avoids overlap and redundancies, and adds value to results on the ground. Yet, quantifying the benefit of integration has been difficult and to date, little on this topic has been published in the peer-reviewed literature.

The article presents quasi-experimental research recently conducted in the Philippines that tested the hypothesis that a specific model of integration – one in which family planning information, advocacy, and service delivery were integrated with coastal resources management – yields better results than single-sector models that provide only family planning or coastal resources management services.

The study collected data from three island municipalities in the Palawan region of the Philippines, where the residents are dependent on coastal resources for their livelihoods. The integrated model was implemented in one municipality, while the single-sector models (one coastal resource management program and one reproductive health management program) were conducted in two separate municipalities.

The results of the study provide strong evidence that the integrated model outperformed the single-sector models in terms of improvements in coral reef and mangrove health; individual family planning and reproductive health practices; and community-level indicators of food security and vulnerability to poverty. Young adults – especially young men – at the integrated site were more likely to use family planning and delay early sex than at the sites where only family planning and reproductive health interventions were provided.

Coral reef health – as measured by a composite condition index – and mangrove health increased significantly at the integrated site, compared to the site where only coastal resource management interventions were provided. Data from the integrated site also showed a significant decline in the number of full-time fishers, as well as fewer people who knew someone that used cyanide or dynamite to fish – both factors that amplify a community’s vulnerability to food insecurity. Finally, the proportion of young people with income below the poverty threshold decreased by a significant margin in areas where the integrated population and coastal resources management (IPOPCORM) model was applied.

Let’s hope this research is just the beginning of a more thoughtful and effective approach to meeting multiple development goals in a lasting manner

Educational activities at the integrated site focused on illuminating the intrinsic relationship between fast-growing coastal communities in the Philippines and the diminishing health of the coral reefs and fisheries that they depend on for food and livelihoods. Community change agents, often fishermen and their families, talked to their neighbors and fellow fishers about the importance of planning and spacing families and establishing and respecting marine reserves to protect the supplies of food from the sea. They referred those interested in family planning to community-based social marketers of contraceptives or the nearest health center for other services.

These same community members also participated in activities to sustainably manage their coastal resources: working with local government officials to establish marine reserves, replant mangroves, serve as community fish wardens to patrol those reserves, test out alternative livelihoods such as seaweed farming, and start small businesses to diversify their income and reduce fishing pressure.

Development professionals should pay close attention to the conclusions of this study. In environmentally significant areas where human population growth is high, it will be difficult to sustain conservation gains without parallel efforts to address demographic factors and inequities in the distribution of health and family planning services. Integrating responses to population, health, and environment (PHE) issues provides an opportunity to address multiple stresses on communities and their environments and, as this study demonstrates, adds value in such a way that significantly improves community resilience and other outcomes.

This research allows those of us who believe strongly in integrating population, health, and environment programming to point to quantitative proof that the approach works. We now need to expand PHE programming to reach more people in other parts of the world where communities face a similar nexus of challenges. New initiatives have started taking the lessons from this research, applying them to new contexts in Africa and Asia, and scaling them up to reach many more in the Philippines.

Let’s hope this research is just the beginning of a more thoughtful and effective approach to meeting multiple development goals in a lasting manner in the places that need it most.

Leona D’Agnes is the technical director of IPOPCORM, Joan Castro is the executive vice president of PATH Foundation Philippines Inc, and Heather D’Agnes is the Population, Health, Environment Technical Advisor in the U.S. Agency for International Development’s (USAID) Office of Population and Reproductive Health.

Thank you very much for this informative article…this integrated approach of addressing demographic, health, family planning and environmental issues at the community level and enlisting active involvement of local community members makes complete sense….and note that there is an important education process going on as well!! I am wondering over what period of time this work/experiment occurred? Please keep me informed…buck627@gmail.com Thank you, Craig Buckley, M.D.

Leona D’Agnes

Thank you for the encouraging remarks, Dr. Buckley. In response to your question, the field research took 6 years to generate statistically significant results. Another 2+ years of desk work were required to verify and analyze the data, document the methodologies and findings, and prepare the journal article which went through several revisions based on feedback from both internal and external peer reviewers.

PATH Foundation Philippines has since adapted the approach for use among communities living in critical watershed areas of Southern Philippines and exported the model to other countries in Asia (Nepal) and Africa (Tanzania, Ethiopia and Ghana) under USAID's global PHE initiative called the BALANCED Project.

What are your hypotheses regarding why the integrated approach was so much more successful? As a marine ecologist, the results presented here lead me to be optimistic for future development in the Philippines, but I wonder what actually allowed the integrated plan to be more successful? Also, will there be continued monitoring of the environmental variables presented? That is, what will be the longer term impacts of the integrated approach vs the single method(s) on coral health/fishing/mangrove destruction?Thanks.R. Dunn

http://www.blogger.com/profile/12871749575352820527 ECSP Staff

[From Leona D'Agnes]

Hello Dr. Dunn,

Thank you for your comments, questions and the opportunity to discuss some of our theories about why the integrate approach yielded higher impacts compared to the sectoral-managed programs.

One hypothesis is that the multi-disciplinary interventions applied in the IPOPCORM study areas generated multiple impacts and positive feed-back loops that were mutually reinforcing and created a synergistic effect not seen in the single-sector or one-dimensional program sites.

Over the 6-year course of the study, the average number of household members declined in the IPOPCORM site as did the number of full-time fishers and the number of people living in poverty. The same site witnessed a simultaneous increase in the number of environmental stewardship acts and the number of marine protected areas (due in large part to the dedication and vigilance of collaborating Peoples Organizations). The affects of reduced population pressure and reduced fishing effort may have amplified the impacts of protected area management resulting in changes that people could quickly see as the consequences of their actions (which, in turn, served to reinforce desired behavior change at the individual and community levels).

A second hypothesis is based on the work of Donella Meadows – a scientist and system analyst who identified 12 levers (places within a complex system) where a "small shift in one thing can produce big changes in everything." One such lever is a society’s paradigm or mindset (a collective idea or unstated assumptions that are sources of systems). Another is the power to transcend paradigms by changing the values and priorities that lead to the assumption in the first place.

PFPI’s baseline (2001) surveys revealed the wide-spread perception among coastal respondents that “our community is helpless in protecting its environment.” The project worked to change this negative mindset by encouraging communities to work with and through their local Barangay Development Councils to formulate a new vision and priorities that centered on community empowerment and self-reliance for family planning and coastal habitat protection in order to assure food security from the sea. And IPOPCORM enabled the paradigm shift via the introduction of CRM, fertility management and alternative livelihood tools and methods. Similar paradigm shift was not evident in the single-sector sites which could explain why IPOPCORM was more successful.

Lastly, you asked about continued monitoring of the environmental variables in the study area. We concur that such monitoring is needed to assess the long-term impacts of the integrated approach on human and ecosystem health outcomes. Unfortunately, grant support for PHE research has dwindled over the years and PFPI currently lacks funds to conduct follow-up surveys in the Palawan study sites. However, we are hopeful that this publication will stimulate a renewal of interest among donor organizations in PHE in general and operations research activities in particular.